The greatest potential for child maltreatment prevention effectsis with high-risk populations. Unfortunately, home-visiting child maltreatment prevention programs have failed to prevent child maltreatment in the highest-risk populations, such as families with parental substance use disorders, intimate partner violence IPV), parental depression or other multiple risk factors. These discouraging results with high risk populations may be best understood as a mismatch of service aims and family needs. In many respects, high-risk child maltreatment prevention populations have more in common with child welfare cases than with perinatal prevention populations. Reductions in child maltreatment recidivism with child welfare populations has been found with the home-based intervention model SafeCare, a promising intervention for high-risk child maltreatment prevention. OUHSC has conducted a randomized pilot and feasibility trial of SafeCare, enhanced with specific components to address substance abuse, IPV, and depression in high risk prevention populations(SC+). The initial results are encouraging.The overarching goal of the proposed project is to extend our current work by conducting a full-scale randomized efficacy trial of the SC+ protocol with a high risk child maltreatment prevention population. The main hypotheses are: Hypothesis1: Compared to services as usual(SAU), high-risk parents randomized to receiveSC+ will have improved survival for future child welfare reports,and will have lower rates of out-of-home placements due to child maltreatment. Hypothesis2: Compared to SAU, families randomized to receive SC+ will show greater improvements on factors proximal to childmaltreatment, including observed measures of the home environment, home safety, physical childcare, and self-reports of verbal and physical aggression toward children. Hypothesis3: Compared to SAU, high-risk parents randomized to receiveSC+ will show greater improvements on risk factors, including measures of child abuse potential, levels of IPV, depression and substance abuse.